What the Science Tells Us About Making Football Safer This CTE Awareness Day

UPDATE, February 2, 2018: This post originally failed to mention the organization that started CTE Awareness Day, Faces of CTE. It has since been corrected to include information about this organization and their achievements to educate and raise awareness about the disease and its causes since the first CTE Awareness Day.

As the most high-profile football game of the year approaches this weekend, not everyone will be thinking about trophies and victory speeches. Families and friends of players who have faced long-term health consequences from playing the sport will be focusing on their loved ones. Today is the second annual Chronic Traumatic Encephalopathy (CTE) Awareness Day, during which we should all take some time to think about how the health of players can be prioritized through institutional reform, rule improvements, and policy changes supported by evidence. It’s the very least we can do to offer support to the football players who reliably delight us with their athleticism on game days.

CTE Awareness Day was launched last year as part of a project of Faces of CTE, an organization formed by the families of children, teens, and adults who were victims of this traumatic brain disease. Faces of CTE works with the Mayo Clinic Brain Bank and is calling upon people whose loved ones have died and have a history playing football to donate their brains to further scientific knowledge about the disease. In an effort to raise awareness about the disease and the risks of playing football, especially for kids, Faces of CTE also launched a campaign to promote flag football under 14 in 2017.

Another organization, the Concussion Legacy Foundation, and its partners kicked off a similar awareness campaign to limit tackle football to children 14 years and older. Led by co-founder and CEO, Chris Nowinski, the organization has been working with scientists at Boston University to continue research on the pathology of CTE, to raise awareness about the degenerative brain disease, and to make football safer. There is still much research to be done, but initial studies on head injuries in children playing tackle football reveal a troubling pattern. A 2018 study published in the journal Brain of the impacts of subconcussive hits in mice revealed that head injuries, independent of concussions, can trigger neurophysiological changes and lead to the development of CTE pathology. A 2017 study coauthored by the Boston University clinical research team found that participation in youth tackle football before age 12 increases the risk of behavioral issues like impaired mood and cognition later in life. This builds upon a 2016 Wake Forest University study that found measurable changes to the structural integrity of the brain, due to repeated subconcussive hits, after children aged 8 through 13 played just one season of youth football.

New policies aim to protect kids

While there is no definitive proof of a “safe” age to play football, the evidence now appears strong enough to support protective policies that will help to prevent these injuries from occurring in children whose brains are still developing and most sensitive to hits. Illinois and New York are leading the way with the introduction of bills that would prohibit children under 12 years old from playing tackle football in organized youth football leagues and schools. And this January a bill was introduced in Ohio and resolutions were introduced in Indiana, Iowa, California, and Pennsylvania to designate January 30th as CTE Awareness Day, remembering the lives of young men who have died as a result of repetitive head injuries incurred while playing tackle football.

In New York, state senator Michael Benedetto introduced the John Mackey Youth Football Protection Act, named after the NFL player from New York who developed severe dementia and passed away in 2011. Benedetto first sponsored the legislation in 2013 because, “I firmly believe that when we see evidence of the danger to children, we need to act on that…there are laws that you need to use a car seat, wear a bicycle helmet. It’s the same principle.”

In Illinois, representative Carol Sente introduced the Dave Duerson Act, named after the former Bears player who took his own life in 2011. She, like Benedetto, cited the evidence of harm as the primary reason for introducing legislation. At a press conference, Sente said, “As the science and the data move forward and progress, so must we, and we now turn our attention to CTE… children as young as five are playing tackle football. … They are taking hits in practice and at games, with forces that are similar to what college players are taking.”

Chris Borland, former NFL player and UCS science champion, cut to the chase on a panel at Aspen Institute last week, saying “Let’s take it out of the hands of kids who are five and six and seven years old, and parents who get their information from industries that stand to make billions of dollars from their children playing…leave it up to good research and make laws that protect kids. We’ve done more with less information, from car seats to cigarettes and all that. So I think it’s past due.” Borland’s primary interest is in getting kids through childhood safe from cognitive or emotional harm.

Chris Borland spent some time with our cast of youth football players after filming a PSA with UCS in summer 2017.

Concussion Legacy Foundation’s Chris Nowinski said at an Illinois press conference, “The more years you play, the greater the risk of CTE…The only way to (shorten) the years of tackle football is to prevent it at the beginning.” The organization put together the “All-Time Greatest Team” of former NFL players who did not play football until entering high school to show that you don’t need to play as a kid to excel. The impressive roster includes New England’s Super Bowl stud, Tom Brady.

NFL needs to be refereed

Children must continue to be protected through stronger policies and education campaigns, and the NFL must be held accountable for its unsavory history of aggressive marketing to kids and their parents. In 2007, the NFL hired marketing firm, Brandissimo, in order to “get to kids as early as possible,” according to a former employee. A 2015 report by the Campaign for a Commercial-Free Childhood found that the NFL markets itself to young children through fantasy football apps like NFL Rush tailored to children six to 11, through government-sponsored programs that promote physical activity but are often undermined by partnerships with fast food companies and screen time promotion, and through educational materials for schools claiming to teach real subjects using NFL-branded terms and visuals.

These tactics are eerily similar to some of the marketing techniques used by the food industry to hook young kids on junk food. Not only is the NFL targeting kids, but it has used its platform to misinform moms about the research on the link between playing football and brain injuries using “Moms Football Safety Clinics.” At one of these clinics in Birmingham, Alabama, the Falcons’ community relations coordinator told moms that “concussions are on the rise…at least in the media,” and failed to mention CTE entirely. In a Chicago clinic, a trainer with USA Football told a mom who asked when parents should let their kids play football that if a child’s neck is strong enough to hold up a helmet, that’s a “good indicator” that they might be ready. The NFL’s obfuscation of the facts needs to stop so that parents can make informed decisions about enrolling their teenagers in this sport.

In order to keep children and adults safe, the NFL needs to stop sidelining science and start prioritizing the health of its past, current, and future players. The fact remains that the development of brain pathologies like CTE is a result of repetitive subconcussive injuries to the brain over time and, as a full-contact sport, football offers many opportunities for these kinds of hits. For football to be a safer game, the number of head impacts needs to be reduced. And fortunately for football fans, there are some ways to reduce the risk without pulling the plug on the NFL and the NCAA entirely, including non-contact practices, mandatory medical staffs, required education about brain trauma for athletes at all levels, and swift removal of players who have signs of serious head injuries. These leagues have no excuse for not implementing these reforms as soon as possible. And families of CTE victims and advocates will not stop fighting until change happens. Kimberly Archie, one of the founders of Faces of CTE and a long-time child athlete safety advocate, wrote in Huffington Post this week, “Moms, and parents in general, are by nature designed to protect our kids. We deserve a seat at the table until the initiatives we’ve put forth are adopted, and we’ll keep kicking up dust until they do.”

There have been stunning advancements in the science on CTE just in the past decade. However, there must be authentic buy-in from the NFL, NCAA, and high-school football programs to reduce the risk of CTE in players. It’s time to listen to the science for all those we remember this CTE Awareness Day.

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Olympicdoc

About 40 million kids play youth sports. The decision to play or not to play is in the hands of the parents. I agree with your comments, “we should all take some time to think about how the health of [youth] players can be prioritized.”

What is being missed given the media focus on concussion and CTE is the total lack of safety preparedness in all youth sports: no athletic trainers (games AND practices); no emergency action plan; no required CPR/AED training, no brain injury, sudden cardiac arrest, heat, asthma, seizure, anaphylaxis, sickle cell trait, diabetes, etc. training. No immediate access to emergency contact and medical information. No concussion Remove from play/Return to play SYSTEM of documentation, communication, and oversight. No heat plan.

The Dunning-Kruger effect is in full force. Our lay parents and coaches are woefully under educated yet confident that they are prepared. They don’t even know what they don’t know. Add an optimism bias – “it won’t happen to us” – and the huge lack of medical literacy and you have a mess.

As risk management expert Dr. Edward Dragan states, “All too frequently, it is only after a tragedy that officials look back and ask, “How could this have been avoided?” Risk management is a far-reaching topic, but when focused on the professional standard of care in educational and other child and youth-serving organizations, it comes down to protecting the safety of participants in the care and custody of a school or other organization.”

Attorney Al Goldberger says, “”… people need to understand that pamphlets won’t do it and laws are not a panacea that if you have a law that all of a sudden magically everything will be OK. Somebody has to know when to have the child taken out and evaluated or the whole thing breaks down.”

Systems can quickly and cost effectively be put in place that allow easy record keeping, real time communication between parents and coaches, and provide a risk management strategy for the sports organization. @teamsafesports

gennareed

Thanks for your comment, Olympicdoc.

You raise a critical point about inadequate safety controls in youth football leagues. While I admit I have not comprehensively analyzed the trends in these leagues, I do agree that parents and coaches must be fully informed about the evidence on the risks of football and best practices for risk mitigation or, better yet, avoidance. These leagues should be required to institute risk prevention strategies, as you suggest, to help keep kids safe.

Olympicdoc

It is not only football leagues. Here are two stories:

1. Shared by a parent:
An orthopedic surgeon who specializes in sports is on the sidelines of a baseball game.
His son is clowning around off to the side (not in the game) and collides with a friend.

Someone notices the collision and tells the doc. His son comes over and says he is “OK.” The doc “examines” him, finds “nothing” and lets him keep playing around. He later goes home with his son.

His son vomits about 3 hours after getting home. The doc rushes him to the hospital. His son is “bleeding” from the brain (sounds like a possible subdural hematoma).

And youth coaches are supposed to know what to do after taking a 20 minute course on concussions? Really?

2. A youth league owner and coach:
Last night I was talking to my neighbor who runs a youth girls volleyball club with about 60 athletes.

2 of his athletes require an EpiPen® due to severe peanut allergy.

I asked him who carries the EpiPen® for these athletes. “The parents.”

I asked him if these parents are at every PRACTICE. “No.”

So who has the EpiPen® at practice? “The parents.”

Do you have any documentation of these medical conditions and the need for an EpiPen®? “No.”

I explained how our platform requires the parent to report the condition and the need for the EpiPen® and provide/deny consent for the coach to carry and/or administer the EpiPen®.

And how this would be documented to cover him, the parent, and the athlete.

And how our course would educate his coaches on anaphylaxis and how to use an EpiPen®.

And that EpiPen instructions are in our platform in the athlete’s profile. And by the way, each athlete should have two EpiPens.

And how everyone would now be on the same page, he and his coaches would know what to do, his parents would have peace of mind, and the athlete would be protected.

You should have seen his face.

He now understands a little better. They will be implementing our platform in the next few weeks.